San Francisco Continues to Lead U.S. in Efforts to End HIV Epidemic

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In the overall effort to end major local HIV epidemics throughout the nation, San Francisco is maintaining its place at the front of the pack, maintaining an impressively steep decline in annual diagnoses of the virus, aidsmap reports. However, in keeping with troubling national trends, the city’s newly released 2016 HIV Epidemiology Annual Report highlights racial disparities, with the epidemic disproportionately affecting Latinos and Blacks compared with whites and Asian Americans.

The San Francisco Department of Health (DPH) report, which includes data through the end of last year, indicates that just 223 people were diagnosed with HIV in San Francisco in 2016, a 16 percent drop since 2015, during which the city registered 265 diagnoses. The city’s diagnosis rate has fallen every year but one since 2007, when the diagnosis rate was 532. The decline in the diagnosis rate accelerated considerably after 2012.

Meanwhile, the Centers for Disease Control and Prevention (CDC) recently estimated that between 2008 and 2014, the annual HIV infection rate dropped a more modest 18 percent nationwide.

Public health experts attribute San Francisco’s success toward an ultimate goal of zero new infections to a combination of factors centered on the power of antiretrovirals (ARVs) to prevent transmission. Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP), which was approved in 2012, has soared in popularity among local men who have sex with men (MSM). Additionally, the city has instigated a major push in recent years to aggressively test for and quickly treat HIV.

Between 2012 and 2015, the median number of days between an individual’s HIV diagnosis and full suppression of the virus through ARV treatment was cut in half, from 148 days to 76 days.

Data also suggest that people with HIV are getting tested earlier and starting treatment earlier in the course of their infection. During this same period, the proportion of those who received an AIDS diagnosis within three months of testing positive for HIV dropped from 21 percent to 16 percent. Between 2009 and 2015, the median CD4 count at an individual’s HIV diagnosis and at the initiation of ARV treatment rose from a respective 410 and 331 to 466 and 451. The narrowed gap within each pair of figures is another indication that individuals are getting treated sooner after diagnosis.

In 2010, San Francisco placed itself at the vanguard of the now global movement to treat HIV universally by becoming the first U.S. municipality to recommend all those with the virus receive ARVs regardless of CD4 count. Gold-standard scientific proof published in 2015 fully vindicated this policy, showing that starting ARVs with a CD4 count above 500 reduces the risk of illness and death compared with waiting for the immune system to deteriorate.

The routes of transmission among those recently diagnosed with the virus in San Francisco include: sex between males (70 percent), injection drug use (9 percent), either sex between males or injection drug use (9 percent) and heterosexual sex (6 percent). Men who have sex with men (MSM) in particular have seen a rising rate of sexually transmitted infections (STIs) in recent years, most notably gonorrhea.

Of the newly diagnosed, 39 percent are white, 28 percent are Latino, 15 percent are Black and 15 percent are Asian or Pacific Islanders. All racial groups saw a declining or stable HIV diagnosis rate. The 2016 diagnosis rate among Black men was 96 per 100,000, compared with 39 per 100,000 among white men. By comparison, the diagnosis rate for Black men was 140 per 100,000 in 2015.

Last year, San Francisco saw no new HIV diagnoses among those ages 13 to 17. Additionally, no one under 13 years old, including infants, has been diagnosed since 2005.

The annual death rate among the local HIV population—16,010 San Franciscans are currently living with the virus—dropped from 257 in 2015 to 165 in 2016. However, the figure for the most recent year may be an underestimate because of delayed reporting.

Thanks to life-extending ARVs, the local HIV population is steadily graying. Sixty-three percent of the group is older than 50, 26 percent is older than 60, 5 percent is older than 70 and 5 percent is younger than 30.

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